This article describes formative research undertaken in Bangladesh, Burkina Faso, Madagascar and Tanzania to inform the context-specific design and implementation of multiple micronutrient supplementation (MMS). Authors conclude that this multi-country MMS project has great potential to improve maternal nutrition and pregnancy outcomes. They believe that investing in collaborative and participatory formative work for the appropriate introduction of MMS in each setting will help ensure MMS does not face the same fate as iron folic acid (IFA), with poor program coverage and compliance globally.